FOLFIRINOX in Locally Advanced Pancreatic Cancer: The Massachusetts General Hospital Cancer Center Experience
Jason E. Faris,Lawrence S. Blaszkowsky,Shaunagh McDermott,Alexander R. Guimaraes,Jackie Szymonifka,Mai Anh Huynh,Cristina R. Ferrone,Jennifer A. Wargo,Jill N. Allen,Lauren E. Dias,Eunice L. Kwak,Keith D. Lillemoe,Sarah P. Thayer,Janet E. Murphy,Andrew X. Zhu,Dushyant V. Sahani,Jennifer Y. Wo,Jeffrey W. Clark,Carlos Fernandez-del Castillo,David P. Ryan,Theodore S. Hong +20 more
TLDR
The use of FOLFIRINOX was associated with conversion to resectability in >20% of patients and the toxicities observed with the use of this regimen raise important questions about how to best treat patients with LAPC.Abstract:
The objective of our retrospective institutional experience is to report the overall response rate, R0 resection rate, progression-free survival, and safety/toxicity of neoadjuvant FOLFIRINOX (5-fluorouracil [5-FU], oxaliplatin, irinotecan, and leucovorin) and chemoradiation in patients with locally advanced pancreatic cancer (LAPC). Patients with LAPC treated with FOLFIRINOX were identified via the Massachusetts General Hospital Cancer Center pharmacy database. Demographic information, clinical characteristics, and safety/tolerability data were compiled. Formal radiographic review was performed to determine overall response rates (ORRs). Twenty-two patients with LAPC began treatment with FOLFIRINOX between July 2010 and February 2012. The ORR was 27.3%, and the median progression-free survival was 11.7 months. Five of 22 patients were able to undergo R0 resections following neoadjuvant FOLFIRINOX and chemoradiation. Three of the five patients have experienced distant recurrence within 5 months. Thirty-two percent of patients required at least one emergency department visit or hospitalization while being treated with FOLFIRINOX. FOLFIRINOX possesses substantial activity in patients with LAPC. The use of FOLFIRINOX was associated with conversion to resectability in >20% of patients. However, the recurrences following R0 resection in three of five patients and the toxicities observed with the use of this regimen raise important questions about how to best treat patients with LAPC.read more
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Journal ArticleDOI
Predicting a Response to FOLFIRINOX in Pancreatic Cancer
Ryan D. Nipp,David P. Ryan +1 more
TL;DR: The value of carboxylesterase 2 (CES2) as a potential predictive marker for patients receiving neoadjuvant FOLFIRINOX was investigated and it was found that CES2 was elevated in pancreatic cancer cell lines more so than other cell lines, but also with heterogeneity in expression levels.
Journal ArticleDOI
Cost‐effectiveness of neoadjuvant FOLFIRINOX versus gemcitabine plus nab‐paclitaxel in borderline resectable/locally advanced pancreatic cancer patients
Myles Ingram,Brianna N. Lauren,Yoanna Pumpalova,Jiheum Park,Francesca May Ting Lim,Susan E. Bates,Fay Kastrinos,Gulam Abbas Manji,Chung Yin Kong,Chin Hur +9 more
TL;DR: The 2020 National Comprehensive Cancer Network guidelines recommend neoadjuvant FOLFIRINOX or neoad juvant gemcitabine plus nab‐paclitaxel (G‐nP) for borderline resectable/locally advanced pancreatic ductal adenocarcinoma (BR/LA PDAC).
Journal ArticleDOI
Novel directions in neoadjuvant therapy for pancreas adenocarcinoma
TL;DR: The historical precedent as well as the current state of affairs regarding neoadjuvant therapy in resectable and borderline resectables pancreatic adenocarcinoma are examined.
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Pharmacological Modulation of Apoptosis and Autophagy in the Treatment of Pancreatic Cancer.
Nityaa Selvarajoo,Johnson Stanslas,Mohammad Kaisarul Islam,Sreenivasa Rao Sagineedu,Kok Lian Ho,Jonathan Lim +5 more
TL;DR: Many small-molecule anticancer agents have been developed to regulate autophagy and apoptosis associated with pancreatic cancer treatment, where most of them target apoptosis directly through EGFR/Ras/Raf/MAPK and PI3K/Akt/mTOR pathways.
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